HOUSTONUsing subjective complaints reported by patients as a basis for
treatment is new, "in a sense revolutionary," said Charles S.
Cleeland, PhD, and worth pursuing. Well-established pain measurement scales
can be used as a model to assess multiple symptoms, including fatigue, among
cancer patients and identify moderate to severe levels of symptoms that
might warrant intervention, he explained. Dr. Cleeland is McCullough
Professor of Cancer Research at the University of Texas M.D. Anderson Cancer
Center in Houston.

"Fatigue nests within a much larger set of cancer-related
symptoms," he said. "These symptoms are present not only for weeks
but often months," and "many symptoms such as fatigue persist
dramatically after therapy."

Dr. Cleeland introduced the concept of "symptom burden,"
although he did not coin the term. Symptom burden is defined as "the
combined impact of all the symptoms (related to disease or therapy) on the
ability of persons to function as they did prior to the onset of the disease
and/or therapy."

What’s Driving Demand?

"We’re in an era where there is an increasing demand for better
symptom control," Dr. Cleeland said. Media coverage has increased
awareness of symptom control and "more knowledgeable and demanding
consumers are asking for broad symptom control, and specifically for
fatigue."

The federal government also promotes the concept. Just last year, the
Institute of Medicine called for quality of life and symptom control to be
high priority issues. Dr. Cleeland acknowledged the public policy aspects of
symptom control. "The cost of treatment for the symptom must be
balanced by improved function and comfort and be supported by those who pay
for such treatments," he noted (see Table 1).